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Cardiologist Appointment Questions

I have talked about my friend's cavalier, Kennedy, who I have been trying to get to see a cardiologist. She finally has an appointment scheduled and she wants me to go with her. She doesn't really read up on stuff so that is why she wants me there. I know nothing about MVD but wanted to post to see if maybe there are some things to add to talk to the cardiologist about.

Background:

Kennedy is 7 years old. He was diagnosed with a grade 1 murmur in January. I believe in July around 6 months later, he went back to the vet. He was having difficulty breathing. He was diagnosed with a Grade 3 murmur and had fluid in his lungs. The vet showed my friend how large his heart was and put him on lasix and told her to come back in a couple of weeks. I think they did more xrays and said the fluid was no longer there. This is when I went with her to the vet and he wanted to put Kennedy on several different medications but I suggested she see a cardiologist.

Symptoms:

One of the main things my friend sees that has worried her is at night he will wake up all confused and wakes up several times. Another friend noticed that he stops breathing. She doesn't think this has anything to do with his heart but I do. Either way, the difficulty breathing puts more stress on his heart. I saw him trying to breath during the day and it seemed labored. He also was diagnosed with BAOS and had surgery for that when he was younger. She hasn't noticed any coughing etc. I know she is in good hands with the cardiologist but would you think that could be related?

This is the email that she got with the confirmation. Do these things seem pretty routine for a first time visit?

" Our service is made up of the Cardiologist, Dr. Sayer, and two assistants, Jason and Lane. Most appointments will begin with either Jason or Lane taking a history from you about why are you bringing your animal in and what, if any, signs you have seen. This is an important time to talk about abnormalities like trouble breathing, cough, exercise intolerance, or collapse episodes. It is important for us to understand how long the signs have been occurring, how frequently you are seeing the abnormalities, and if any treatments or changes in lifestyle have improved the signs. This is also a good time to discuss what medications your pet is taking. It is very important for us to know not only which medications you are giving your pet but what the dose is and how often you are giving it.Depending on the age of your pet and why they are coming to see us we might then measure their blood pressure. We like to do this while you are there to decrease their stress. It is a very big help for you to talk to your pet and keep them as relaxed as possible while we take their pressure. Normally we take the blood pressure on their tail so we may need to shave a small area of hair. Sometimes we are not able to easily get their blood pressure and we may try again later in the visit.Dr. Sayer will then visit with you to discuss the plan for further diagnostics. The choices will vary depending on the signs your pet is showing as well as their breed and age. Our testing usually takes a little more than an hour. Once complete we will discuss our findings, any medications needed, and if recheck visits are necessary.We try to provide you with a written summary at the time of your visit but there are times when this is not possible due to a very busy schedule or emergencies. If that is the case, we will mail it to you as soon as possible.DiagnosticsIdeally we perform a complete cardiac work up which includes the blood pressure, electrocardiograph, thoracic radiographs, and an echocardiogram. This provides us with the most complete assessment of the heart. The complete work-up, including the consultation fee, is provided at a discounted price to make it more affordable for our clients. For the times when a complete cardiac work up is not financially viable or is not necessary for the patient in question, we will perform individual tests as needed.

Consultation: Includes gathering the patient history, a complete physical exam paying special attention to the cardiovascular structure, formation of a plan for treatment, and preparation of a written summary of the visit provided to you and your veterinarian $155.50

Blood pressure: Provides an indication of how well the heart is [/FONT]
working as well as the vascular resistance (the main force that a normal heart works against). Just as in humans, when the blood pressure is elevated, the heart is overworked and that can contribute to heart disease. Many of the medications that we give to animals with heart disease affect their blood pressure and it is important for us to monitor these changes. $32.75

Electrocardiogram: Allows us to assess your pet’s heart rate as well [/FONT]
as the rhythm. Like people, animals can have abnormal heart rhythms that make the heart beat too slow or too fast. They can also have abnormalities of conduction that are an important indication of heart disease. $75.00

Thoracic radiographs (Chest x-rays): Allows us to measure the size of the cardiac silhouette and assess the effect the heart is having on the vasculature of the lungs. $156.75

Echocardiogram (cardiac ultrasound): Technology that uses ultrasonic
waves to create a picture of the heart. We can evaluate its motion, the strength of the heart muscle, the function of the valve and we can estimate the pressures within the heart. We have to shave a small area on each side of the chest for good contact of the ultrasound probe.
$304.50

A Complete cardiac work up includes all of these diagnostics for $620.75. There are times when we also need blood work to evaluate kidney, liver, and thyroid function. The price for these tests varies and will be discussed with you as needed."

Is it normal to take blood pressure on the tail? I am just curious about that one. I have heard several good things about this cardiologist and I am SOOO thankful she is going but I would like to understand more for my own self too.

Good that you going with your friend to take Kennedy to a cardiologist. It's always the best option. Everything you mentioned sounds perfectly normal for a first time visit. I don't know anything about taking BP from the tail. Is Sydney's cardio did, they didn't do it in my presence or shave any part of his tail. Cost-wise, Sydney's visits ranged from $600-$1200, depending on tests done or medications purchased. Not all these tests have to be done on follow-up visits.

The one suggestion I have is if the regular vet took an xray, get a copy to bring to the cardiologist so they have a comparison and can see any further progression.

$620.75 for a complete cardiac workup! Cavaliers ain't cheap, and the cheaper they come (from backyard breeders, puppy farms), the likelihood is that the more expensive they become.

True... but it's important for people to not think the opposite. The more expensive they are the less likely they will have health problems. I believe Elton came from a BYB (could have been puppy mill) but family was so proud of the registration papers (something like american registry) with book the breeder gave. I rescued Elton and would never buy a Cavalier without doing proper research etc. Anyway, I didn't know the background of his parents. I did know he was 4 1/2 and did not have a murmur according to vet. I did get pet insurance (I wonder how that works for people who adopt cavaliers with pre-existing conditions). Even though there are no guarantees, it is important to look for breeders who follow the MVD breeding protocol.

There are only 2 things I can suggest: Have your friend make a diary of how he's doing each day (and the time of any issues on that day) up until the appointment; and take a notebook of anything she wants to ask, and to write down notes from the appointment. There will probably be a lot of info coming at her, so if she takes notes, she can "digest" it later. She's so lucky to have a friend like you to go with her!

I'd also suggest that she listen to her dogs chest when the dog is resting. The other day Tess crawled up next to me on the pillow and fell asleep cuddled next to my head. I got a very good listen to her heart and lungs at a time when she was very relaxed. I'm fairly sure she has developed some fluid on her lungs, so we are going in to the vet soon.